Healthcare Provider Details

I. General information

NPI: 1073161956
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ASSOCIATES OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 WARWICK BLVD STE A
NEWPORT NEWS VA
23601-3251
US

IV. Provider business mailing address

4196 MERCHANT PLZ STE 205
WOODBRIDGE VA
22192-5085
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-9088
  • Fax: 757-534-7496
Mailing address:
  • Phone: 804-721-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD ERIC ROMAN
Title or Position: CEO
Credential:
Phone: 804-721-7528